Provider Demographics
NPI:1538119052
Name:BURNS, LANCE STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:STUART
Last Name:BURNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 W WILLOW AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304
Mailing Address - Country:US
Mailing Address - Phone:623-878-5703
Mailing Address - Fax:623-878-5703
Practice Address - Street 1:18701 N 67TH AVENUE
Practice Address - Street 2:ARROWHEAD COMMUNITY HOSPITAL
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-561-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17563207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZ453051001OtherGROUP HEALTH GRP #
AZ860373636OtherHUMANA GROUP #
AZ3981220OtherEVERCARE GROUP #
AZAW1936OtherHEALTHNET GRP #
AZ096687Medicaid
AZ096687Medicaid
AZ28203Medicare PIN